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Klin Padiatr 2012; 224(01): 40-42
DOI: 10.1055/s-0031-1298020
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© Georg Thieme Verlag KG Stuttgart · New York

Sedation of Children during Measurement of CSF Opening Pressure: Lack of Standardisation in German Children with Pseudotumor Cerebri

Sedierung von Kindern zur Messung des Liquoröffnungsdruckes. Fehlende Standards bei deutschen Kindern mit Pseudotumor cerebri
D. Tibussek
1   Department of General Pediatrics, University Children’s Hospital Duesseldorf, Germany
,
F. Distelmaier
1   Department of General Pediatrics, University Children’s Hospital Duesseldorf, Germany
,
S. Kummer
1   Department of General Pediatrics, University Children’s Hospital Duesseldorf, Germany
,
R. von Kries
2   Division of Epidemiology, Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany
,
E. Mayatepek
1   Department of General Pediatrics, University Children’s Hospital Duesseldorf, Germany
› Author Affiliations
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Publication History

Publication Date:
14 December 2011 (online)

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Abstract

Background:

Diagnosis of pseudotumor cerebri (PTC) requires proper documentation of raised CSF opening-pressure. In childhood results may not be reliable due to insufficient sedation/analgesia or drug effects. We aimed to evaluate the current practice regarding pain and stress management in children undergoing lumbar puncture (LP) for pressure measurement.

Methods:

A one-year survey was conducted involving 368 German paediatric departments. All children with newly diagnosed PTC should be reported. Details analyzed here included: age, sex, CSF opening pressure and type of procedural sedation and analgesia (PSA) during LP.

Results:

61 patients were analyzed, aged 6 months to 17 years. 29 patients (47%) did not receive any kind of PSA. In children receiving PSA the following regimens were used: Ketamine; Midazolam; Ketamine + Midazolam; Midazolam + Piritramide; Propofol; Profofol + Midazolam; general anaesthesia.

Conclusion:

Pain and stress management in children undergoing LP for CSF opening pressure measurement is often insufficient. Pain, stress and the variability of PSA regimen may be confounders of pressure measurement. In order to prevent false diagnoses of PTC and to obtain comparable results at different centers, a general consensus on PSA in children undergoing LP for CSF opening pressure measurements is required.

Zusammenfassung

Hintergrund:

Die Diagnose Pseudotumor cerebri (PTC) erfordert die akkurate Dokumentation eines erhöhten Liquoröffnungsdrucks. Im Kin­desalter können Messergebnisse durch unzurei­chende Sedierung/Analgesie oder Medikamenteneffekte unzuverlässig sein. Ziel dieser Erhebung war daher, aktuelle Strategien zum Schmerz- und Stressmanagement bei Kindern, die Lumbalpunktionen (LP) zur Druckmessungen erhalten, zu eva­luieren.

Methods:

Es fand eine einjährige Erhebung un­ter Einbeziehung von 368 deutschen Pädiatrie­abteilungen statt. Erfasst wurden alle neu dia­gnostizierten Fälle eines PTC. Hier analysierte Details waren: Alter, Geschlecht, Liquoröffnungsdruck, Art der Analgosedierung während der LP.

Results:

61 Patienten wurden ausgewertet (Alter 6 Monate bis 17 Jahre). 29 Patienten (47%) erhielten keinerlei Sedierung oder Schmerzmedikation. Unter den analgosedierten Patienten kamen verschiedene Regime zum Einsatz: Ketamin; Midazolam; Ketamin + Midazolam; Midazolam + Piritramid; Propofol; Profofol + Midazolam; Allgemeinanästhesie.

Schlussfolgerung:

Das Schmerz- und Stress-management bei Kindern, die eine LP zur Liquoröffnungsdruckmessung erhalten, ist sehr variabel und oft unzureichend. Schmerz, Stress sowie die Art und Variabiliät der Analgosedierung stellen mögliche Störfaktoren der Druckmessung dar. Um Fehldia­gnosen PTC zu vermeiden und zu vergleichbaren Messergebnissen zu kommen, ist ein allgemeiner Konsensus zur Analgosedierung von Kindern während LP zur Liquoröffnungsdruckmessung notwendig.

Key words

pseudotumor cerebri - CSF opening pressure - sedation - lumbar puncture

Schlüsselwörter

Pseudoturmor cerebri - Liquoröffnungsdruck - Sedierung - Lumbalpunktion
 

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